Your doctor as a Facebook 'friend'?

More physicians find social media is key to patient care

To really get a patient's attention, doctors say, you must start from where they are.

And where they are these days may be on their phone or computer, tweeting, texting, posting on Facebook.

But Twitter, blogs and text messaging aren't in the comfort zone of most physicians, even if some of their patients crave that less formal and more accessible relationship.

Wary of laws governing professional conduct and patient privacy, confused by the complicated rules for different social networks and unsure about the consequences of changing how they interact with patients, many have stayed away.

Others, though, have dipped a toe or two into the virtual swirl. And some are pushing for a full-on plunge, saying social media venues are too powerful to ignore.

"I feel physicians are obligated to be online," says Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Everett, Wash., who tweets and blogs as Seattle Mama Doc. "If celebrities are going to be online, then we educated, practicing physicians had better be there too."

Credible health information is often overwhelmed by sales pitches or compelling stories from movie stars who confuse anecdote with evidence, Swanson contends.

At a recent conference for health professionals focusing on the "thin ethical line" between professional boundaries and personal interests, Swanson took the microphone.

Swanson's approach leaves some doctors at a loss. Many say they want to "partner" with patients and realize doctors can no longer simply pontificate to patients who duly obey.

But Twitter? Blogs? Facebook? What about patients' privacy, about squeezing time — unpaid, at that — from an already overbooked day, about inadvertent unprofessional slip-ups?

And what if your patients want to "friend" you?

"I think that's just a really icky idea," said Dr. John Lantos, another conference speaker and director of the Children's Mercy Bioethics Center at Children's Mercy Hospital in Kansas City, Mo.

"I don't respond to 'friend' requests from patients," Lantos said. "What if all your patients were asking you to sleep with them? Does this mean I have to? You just say no!"

Swanson, whose online work is supported financially by Seattle Children's, says that along with getting questions about childhood vaccines and how to cope with separation anxiety, she has faced uncomfortable moments in the virtual world.

She has been told she needs to dye her eyebrows and pluck her nose hairs. "I have really been told I would rot in hell," she said. "You put yourself at risk. You will take punches."

Still, these tools are too powerful to ignore, Swanson said.

"The technology is changing the way I practice," said Swanson, 38. "It's changing the way I learn and understand, it's changing what I know about health care and about pediatrics."

Now, in real time, she knows what patients are talking about, who is influencing them and what she needs to do to steer them toward scientific information.

Using social media, she can let families know that a crib setup pictured in a news story is dangerous for a baby, for example, or weigh in on a breast-feeding controversy.

"We have this really great tool to improve our partnership," she told her colleagues at the conference. "This is an incredible space and an incredible opportunity."

For doctors who couldn't imagine "friending" a patient or worry that the personal-professional boundary could blur to the point it could cause angst on either side, Dr. Jennifer Kesselheim, co-chair of the ethics advisory committee at Dana-Farber Cancer Institute in Boston, offered a few examples.

In one case, a young doctor bonded with the parents of a child with leukemia. Just before the child was to leave the hospital, the mother asked to "friend" the doctor, who agreed, expecting to see the family again and not wanting to insult them.

A few days later, he saw postings from the mother, including pictures from a bar, drinking to celebrate her child's hospital discharge.

Too much information might well change the doctor's relationship with the family, Kesselheim noted.

Doctors and medical students, too, have pushed online boundaries.

For medical students who have grown up with Facebook and Twitter, social media may be difficult to do without when they begin their professional lives.

A majority of medical schools surveyed report unprofessional online conduct by students, Kesselheim noted, but most do not have a social media policy.

A recent survey found that 90 percent of state medical boards reported at least one online professional standards violation by a doctor. In Rhode Island, an emergency room doctor was fired for a Facebook post about an unnamed patient.